Provider Demographics
NPI:1225339534
Name:CHAMPION, BEAU TRAVIS (MSW)
Entity Type:Individual
Prefix:MR
First Name:BEAU
Middle Name:TRAVIS
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 12TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3578
Mailing Address - Country:US
Mailing Address - Phone:951-247-6064
Mailing Address - Fax:951-242-6201
Practice Address - Street 1:3877 12TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3578
Practice Address - Country:US
Practice Address - Phone:951-247-6064
Practice Address - Fax:951-242-6201
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health